From the Guidelines
It is not recommended to stop an insulin drip without bridging, even at a very low rate with tight blood glucose control. When discontinuing an intravenous insulin infusion, a transition protocol is associated with less morbidity and lower costs of care, and is therefore recommended 1. This protocol involves administering a dose of subcutaneous basal insulin 2 hours before the intravenous infusion is discontinued, with the dose calculated based on the insulin infusion rate during the last 6 hours when stable glycemic goals were achieved. Some key points to consider when transitioning from intravenous to subcutaneous insulin include:
- Calculating the dose of basal insulin based on the insulin infusion rate during the last 6 hours when stable glycemic goals were achieved 1
- Ensuring correct dosing when using concentrated insulin (U-200, U-300, or U-500) in the inpatient setting, by utilizing an individual pen and cartridge for each patient and by meticulous supervision of the dose administered 1
- Adopting and implementing a hypoglycemia prevention and management protocol to prevent episodes of hypoglycemia among inpatients 1 Abrupt discontinuation of insulin infusion without bridging can lead to dangerous hyperglycemia and potentially diabetic ketoacidosis in type 1 diabetics, as the body will have no insulin coverage once the IV insulin is rapidly cleared. In clinical practice, it is essential to prioritize caution and follow established protocols to ensure a smooth transition from intravenous to subcutaneous insulin, minimizing the risk of complications and optimizing patient outcomes.
From the Research
Stopping Insulin Drip Without Bridging
- The provided studies do not directly address the question of stopping an insulin drip without bridging when the rate is very low and blood glucose levels are tight 2, 3, 4, 5, 6.
- However, the studies discuss the importance of achieving and maintaining glycemic control in hospitalized patients, and the use of continuous intravenous (i.v.) insulin infusions or intermittent subcutaneous (s.c.) basal-bolus plus correction injections as preferred methods for managing hyperglycemia 2.
- The studies also highlight the need for proactive management of hyperglycemia and the importance of considering factors such as the severity of illness, medications, and inconsistent dietary intake when determining the aggressiveness of therapy to manage blood glucose levels 2.
- Additionally, the studies discuss the benefits of using insulin analogs, such as improved physiologic profile, greater convenience, reduced risk of hypoglycemia, and less weight gain, which may be relevant to considerations around stopping an insulin drip without bridging 3, 4, 5, 6.
Considerations for Stopping Insulin Drip
- When considering stopping an insulin drip without bridging, it is essential to take into account the individual patient's circumstances, including their blood glucose levels, insulin requirements, and overall health status.
- The studies emphasize the importance of careful monitoring and management of blood glucose levels to prevent hypoglycemia and other complications 2, 3, 4, 5, 6.
- However, without specific guidance from the provided studies, it is not possible to provide a definitive answer to the question of stopping an insulin drip without bridging when the rate is very low and blood glucose levels are tight.